Newborn Murmur Evaluation Cheatsheet
Key Concept: Acrocyanosis (blue hands/feet, pink trunk/mucous membranes) is NORMAL in neonates. Central cyanosis (blue mucous membranes) is never normal. Innocent murmur = soft, systolic, well-appearing. PGE1 for duct-dependent lesions. Hyperoxia test: PaO2 <150 = cardiac R-to-L shunt.
| Category |
Key Features |
| Observe & Reassure |
- Soft (≤2/6) systolic murmur in well-appearing neonate
- Normal O2 sat ≥95% on room air
- Pink mucous membranes (central cyanosis absent)
- Acrocyanosis of extremities — normal peripheral vasoconstriction in neonates
- Normal pulses and perfusion throughout
- Murmur likely from transitional circulation (pulmonary flow, closing ductus)
- Re-examine at 2-week newborn visit
- Pulse ox screening per AAP guidelines for critical CHD
|
| Immediate Echo |
- Cyanosis of mucous membranes or trunk — always abnormal
- O2 sat <90% on room air
- Harsh murmur (grade ≥3) or with click
- Fixed split S2 or single S2
- Diastolic component to murmur
- Differential cyanosis (preductal vs postductal O2 difference)
- Echocardiogram within 24 hours if structural CHD suspected
|
| Start PGE1 |
- Suspected duct-dependent cardiac lesion
- Shock as PDA closes on days 1–7 (coarctation, HLHS)
- Absent or diminished femoral pulses → coarctation
- Profound cyanosis unresponsive to O2 → TGA
- Alprostadil (PGE1) maintains ductal patency until surgery
- Side effect: apnea — monitor airway closely
|
| Hyperoxia Test |
- Give 100% O2 via hood; measure PaO2 (ABG)
- PaO2 >150 mmHg → likely pulmonary cause of cyanosis
- PaO2 <150 mmHg → likely cardiac R-to-L shunt
- TGA will NOT respond to hyperoxia (parallel circuits)
- Largely replaced by echocardiography but still conceptually tested
|
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